Provider Demographics
NPI:1801055173
Name:SOUTH EAST NEUROLOGY, LLC
Entity type:Organization
Organization Name:SOUTH EAST NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:803-905-1200
Mailing Address - Street 1:308 W WESMARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1977
Mailing Address - Country:US
Mailing Address - Phone:803-905-1200
Mailing Address - Fax:803-905-1205
Practice Address - Street 1:308 W WESMARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1977
Practice Address - Country:US
Practice Address - Phone:803-905-1200
Practice Address - Fax:803-905-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty